Urogen Flashcards
Narrowest points of male urethra
- Membranous urethra - External urethral orifice
- Bladder neck
- just proximal to navicular fossa
Anatomical relations of vagina - posterior
- Pouch of Douglas
- Rectum
- Perineal body
- Anal canal
Superior relations of the bladder
Apex joined to anterior abdominal wall - median umbilical ligament
Covered by peritoneum
Related to colis of ileum or sigmoid colon
Blood supply to bladder
- Superior vesical artery
- Inferior vesical artery
(Both from internal iliac)
Parts of male urethra
- Prostatic urethra - widest lumen, bounded by internal and external urethral sphincter
- Membranous urethra - 2cm pierces urogenital diaphragm, pelvic #
- Bulbar urethra - straddle injuries, takes a 90degree angle
- Penile urethra - spongy part, travels through corpus spongiosum
Pelvic diaphragm
Separates the perineum from pelvic cavity
- Levator ani
- Coccygeus (s4,s5)
Nerve supply to clitorus
Internal pudendal nerve
Anatomical relations of the vagina - anterior
- Uterine cervix
- Base of bladder
- Urethra
Lateral relations of vagina
- Ureter
2. Pelvic diaphragm
Venous drainage of vagina
Internal iliac
Lymphatic drainage of vagina
Upper 1/3rd - internal and external iliac LN
Lower 2/3rd - superficial inguinal nodes
Lymphatic drainage of external genitalia
Superficial inguinal LN
Lymphatic drainage of scrotum
Inguinal LN
Lumbar nodes
Blood supply of testis
Testicular artery - directly from abdominal aorta (follows embryological decent of testis down the posterior abdominal wall in to deep ring and through the inguinal canal and out via the superficial ring in to the scrotum
Layers of scrotum
- Skin
- Superficial fascia
- Spermatic fascia
- Tunica vaginalis
- Capsule - tunica albuginea
Superficial fascia of scrotum
- Deep layer - colles fascia - continuous with scarpas fascia
- Contains dartos muscle
- Posteriorly attached to perineal body and posterior edge of perineal membrane
Spermatic fascia
- External spermatic fascia - external oblique
- Cremasteric fascia - internal oblique - genital branch of Genitofemoral nerve (cremasteric reflex)
- Internal spermatic facia - transversalis fascia
Tunica vaginalis
Originally an invagination of peritoneal cavity
Becomes shut off from the processes vaginalis as it closes just before birth
Tunica albuginea
Surrounds each testis
Fibrous septa extend inwards and divide testis in to lobules
Anterior relations to right ureter
- Terminal ileum
- Caecum
- Appendix
- Ascending colon
At its origin usually covered by descending part of duodenum
On its course lies to the right of IVC
Anterior relations of left ureter
- Descending colon
- Sigmoid
- Lies behind sigmoid mesocolon as it enters the pelvis
Crossed Medially to laterally by gonadal vessels
Female ureter
- Crossed anteriorly by uterine arteries
2. Closely related to cervix
Male ureter
Within the pelvis the vas deference crosses anterior to ureter just before it enters the bladder
Posterior relations of ureter
- Psoas
2. Cross bifurcation of common iliac artery
Narrowings of the ureter
- Pelviuriteric junction
- Bifurcation of the iliac vessels where ureters enter the pelvic
- Vesicoureteric junction
Blood supply to the ureter
- Upper third - renal artery and vein
- Middle third - gonadal artery and vein
- Lower third - superior vesical artery and vein
Lymphatic drainage of ureter
- Para aortic LN
2. Pelvic LN
Innervation of ureter
Sympathetic T10 - L2
Parasympathetic S2 - S4
Vas deferens
Arises in continuity with tail of epididymis
Passes superomedially though scrotum and though the inguinal canal to the deep ring and abdominal cavity
As it enters the abdomen it hooks around the inferior epigastric artery
It crosses the ureter at the level if the ischial spine and passes infero Medially on the posterior surface of the bladder towards the seminal vesicle
Right and left crura
Covered in its outer surface by ischiocavernosus muscle
Attached to inferior pubic rami and perineal membrane
Continues anteriorly as corpora cavernosa
Surrounded by Tunica albuginea
Bulb
Attached to the centre of the peroneal membrane and surrounded by bulbo spongiosis muscle
Forward continuation of bulb corpus spongiosum which surrounds Penile urethra
Arterial supply penis
Common Penile artery a terminal branch of internal pudendal artery
Venous drainage of penis
Dorsal vein of penis to prostatic venous plexus
Nerves supply to penis
Pudendal nerve
Lymphatic drainage of the penis
Inguinal nodes
Iliac lymph nodes
Where does the ureter enter the bladder?
Upper lateral aspect of the base of bladder
Ureter
25-35cm
Transitional epithelium
Retroperitoneal overlying TP L2-5
Anterior to bifurcation of iliac vessels
Lymphatic drainage of cervix
Internal and external iliac LN
